Robotic surgery

The term “robotic surgery” can give the impression that a machine performs the procedure.

This is not the case.

The surgeon controls the instruments during the operation from a console located in the operating room.

His movements are transmitted to the instruments positioned inside the abdomen through the robotic arms.

The surgeon also controls the camera and remains responsible for every step of the procedure.

The robot is a technological interface between the surgeon’s gestures and the surgical instruments.

One of the immediately visible features of Hugo™ is its modular architecture.

Unlike an architecture in which several arms originate from a single central unit, Hugo™’s arms are mounted on independent carts.

They can be positioned around the patient depending notably on:

• the procedure
• the anatomy
• the patient’s position
• the chosen access routes
• and the surgical strategy

This architecture allows different system configurations.

Hugo™ uses an open console.

The surgeon sits in front of a screen and wears glasses enabling three-dimensional visualization.

His hands use controllers to command the instruments.

Unlike a console enclosed around the face, this architecture allows the surgeon to maintain direct visual contact with the operating environment.

This feature is also valuable for:

• communication with the team
• observation
• teaching
• and proctoring

In minimally invasive surgery, the surgeon operates while observing the surgical field on a screen.

With Hugo™, the surgeon has HD 3D visualization.

Perceiving depth and the relationships between anatomical structures contributes to analyzing the surgical field and performing technical gestures.

This visualization can be particularly valuable when the procedure requires precise dissection in a complex anatomical space.

The instruments used with the robotic platform have several degrees of freedom.

Their articulated tip allows the surgeon to perform movements inside the body that differ from those obtained with certain rigid laparoscopic instruments.

This mobility can be useful for certain gestures such as:

• dissection
• grasping
• suturing
• and working in restricted anatomical spaces

The quality of the gesture nevertheless always depends on the surgeon who commands the instrument.

Conventional laparoscopy already allows many abdominal procedures to be performed through small access routes.

Robotics therefore does not make laparoscopy obsolete.

It instead adds another tool to minimally invasive surgery.

Certain features can be valuable when a procedure notably requires:

• meticulous dissection
• good depth perception
• intracorporeal suturing
• significant instrument mobility
• or work in a restricted anatomical space

The goal is to choose the approach appropriate to the procedure.

Certain colorectal procedures require working deep within the pelvis.

The available space there is limited and several important anatomical structures lie close to one another.

The three-dimensional vision and instrument mobility offered by robotics then constitute valuable technical features for the surgeon.

Laparoscopy and robot-assisted surgery share a common principle:

In laparoscopy, the surgeon directly manipulates the instruments.

In robot-assisted surgery, the surgeon commands the instruments from a console.

These two approaches should not be presented as two levels of a hierarchy.

The choice depends on numerous factors, including:

• the nature of the procedure
• the anatomy
• the patient’s history
• the surgical strategy
• and the team’s experience

Depending on the indication and the patient’s situation, robotic assistance can be integrated into different procedures.

In my practice, its development notably concerns certain fields of:

for certain procedures on the colon and rectum;

for certain procedures performed as part of the surgical treatment of obesity;

when the characteristics of the procedure make this approach relevant.

The technical possibility of performing a procedure with the robot does not mean it is necessary to use it in every patient.

Robotics can be used for certain colorectal procedures. → Colon Cancer

On September 26, 2025, I performed the first Roux-en-Y gastric bypass assisted by the Hugo™ RAS platform in Switzerland, at GHOL – Nyon Hospital.

This procedure was an important milestone in the development of robot-assisted bariatric surgery within our institution.

But a technical first is not an end in itself.

The goal is to integrate this technology into a structured surgical practice combining:

• selection of indications
• surgical experience
• training
• teamwork
• and ongoing evaluation of practices

During a robot-assisted procedure, the lead surgeon works from the console.

But a team remains present around the patient.

Depending on the procedure and the organization of the operating room, several professionals take part in patient care:

• surgical assistant
• scrub staff
• anesthesia team
• operating room staff

Coordination between the console and the team at the patient’s side is an integral part of robotic surgery.

It is one of its tools.

Robotic assistance allows certain procedures to be performed according to the principles of minimally invasive surgery.

Depending on the operation and the patient’s situation, this can notably be part of a care pathway based on:

• limited abdominal access routes
• progressive postoperative mobilization
• structured recovery
• and modern perioperative care protocols

However, the technology used to operate must be distinguished from the final clinical outcome.

The outcome depends notably on:

• the disease
• the procedure
• the patient
• the gesture performed
• the team’s experience
• and the postoperative course

The sophistication of a device never replaces the fundamentals of surgery.

A robotic practice notably requires:

• precise knowledge of anatomy
• mastery of the procedure
• knowledge of the platform
• anticipation of difficulties
• the ability to change strategy if necessary
• and a trained team

Training therefore concerns not only the surgeon seated at the console, but the entire surgical organization.

I am a proctor for the Hugo™ RAS platform.

This activity consists of supporting surgeons in their learning and skill development on the platform.

Robotic training does not concern only the movements performed at the console.

It also involves understanding:

• system preparation
• cart positioning
• arm configuration
• surgical setup
• instrument use
• communication with the team
• and the overall organization of a robot-assisted procedure

This teaching and knowledge-transfer activity is described in more detail on the Surgical Teaching & Research page.

This commitment also reflects the continuity of his academic career, notably within the National Academy of Surgery.

The development of robotic surgery at GHOL also has an educational dimension.

The surgery department regularly welcomes surgeons and teams for training on the Hugo™ platform.

Learning can thus take place in the real environment of a surgical team and is not limited to the surgeon seated at the console.

Patient positioning, cart arrangement, instrument management, surgical assistance and team coordination are all part of a comprehensive understanding of the platform.

This activity allows GHOL to take part in the transfer of robot-assisted surgery skills.

The console’s open architecture allows the surgeon to maintain communication with the people present in the room.

In a training context, the surgeon in training and the proctor can also share the three-dimensional visualization of the surgical field.

The instructor can thus observe at the same time:

• what the surgeon sees
• how the procedure unfolds
• and how the controls are used

This configuration promotes teaching directly integrated into the operating environment.

Mastering a robotic platform does not rest on a single procedure.

Learning is progressive and combines different dimensions:

• understanding the system
• simulation
• training in instrument handling
• surgical setup and organization
• observation
• supervised procedures
• proctoring
• then progressive development of autonomy

This progression also concerns the surgical team.

Certain rectal procedures require deep dissection within the pelvis.

The rectum is surrounded by important anatomical structures, notably nervous, urinary and genital.

In the lowest procedures, the proximity of the pelvic floor and the sphincter complex further adds to the anatomical complexity.

Whatever route is used, the quality of dissection remains fundamental.

Robotic assistance can provide a valuable technical environment for some of these gestures.

Certain rectal procedures can be performed by robot-assisted surgery. → Rectal Cancer

Certain bariatric surgery procedures involve steps of dissection and digestive reconstruction performed by a minimally invasive route.

Robotic assistance allows the surgeon to use the platform’s three-dimensional visualization and articulated instruments during these gestures.

At GHOL, this activity is part of a multidisciplinary approach to obesity care.

Certain bariatric surgery procedures can be performed with robotic assistance. → Obesity Surgery

Having a robotic platform does not mean every operation must be performed with it.

Depending on the situation, a procedure can be performed:

• by conventional laparoscopy
• with robotic assistance
• or by open surgery

The choice of surgical approach must remain individualized.

It notably depends on:

• the disease
• the procedure
• the anatomy
• the patient’s history
• the clinical situation
• and the team’s experience

The surgical indication is determined according to the disease and the patient’s situation.

The surgeon then evaluates which approach is appropriate.

The procedure is performed under general anesthesia.

The patient is positioned as required for the operation.

The minimally invasive access routes are established.

The Hugo™ carts are then positioned around the patient according to the chosen configuration.

The surgeon takes a seat at the open console.

He controls the camera and the instruments while the team remains at the patient’s side.

At the end of the operation, the instruments are removed and the patient is transferred to the appropriate postoperative care.

There is no identical recovery for every operation performed with Hugo™.

A colonic surgery, a rectal procedure and a bariatric surgery remain different operations.

The length of hospital stay and the resumption of:

• eating
• walking
• work
• sport
• and usual activities

mainly depend on the procedure performed, the patient’s condition and their postoperative course.

The evolution of surgery has always rested on the combination of several elements:

• anatomical knowledge
• experience
• technique
• innovation
• teamwork
• and transmission

Robotic surgery is part of this continuity.

My activity around Hugo™ today combines:

The robot does not replace surgical expertise.

Dr Pierre Fournier
General and Visceral Surgery
Co-Head Physician of the Surgery Department — GHOL
Proctor Hugo™ RAS

Hugo™ gives the surgeon a modular architecture, three-dimensional visualization and articulated instruments.

But the main question is never:

It is:

When robot-assisted surgery provides a relevant technical environment, Hugo™ is one of the tools available to carry out this strategy.